L N E W S F R O M ...

22 • CARING FOR THE AGES
APRIL 2007
N E W S
F R O M
Expect Transitions of
Care to Top Agenda
L
ook for transitions of care issues to dominate AMDA’s
agenda in the next year.
In addition to discussing the
Centers for Medicare and Medicaid Services’ Rebalancing Long
Term Care Demonstration at the
annual symposium in Hollywood,
AMDA has been having a dialogue with
the American Health
Quality Association on
how transitions of
care might fold into
the 9th Scope of Work.
AMDA also will be
meeting with the CMS
Long Term Care Task
Force to seek a requirement for a
narrative discharge summary to be
used across settings, and will be
participating in the National Transitions of Care Coalition.
AMDA is off to a quick start this
year on addressing these issues. In
January, the association joined the
newly formed National Transitions
of Care Coalition, which seeks to
improve the quality of care between health care settings.
AMDA’s Dr. Richard Schamp,
CMD; Jacqueline Vance, R.N.,
CDONA; and Dr. James Lett, II,
CMD, are participating in the
work groups on tools and resources, concepts and health policy, and education and awareness.
The 9th Scope of Work will not
be issued until mid-2008, AMDA
has been in discussions with the
American Health Quality Association (AHQA), which represents
Quality Improvement Organizations (QIO). AHQA likely will propose QIO involvement in transitions of care and AMDA wants to
be sure we are supportive of any
efforts to improve the
quality of care across
the long-term care
(LTC) continuum.
In March, a panel including CMS’ Melissa
Hulbert, Dr. Cornelius
Foley, CMD, and Dr.
Schamp discussed
CMS’ Rebalancing
Long Term Care Demonstration
and its implications for those who
practice in LTC settings, such as
the PACE (Program of All-Inclusive Care for the Elderly) model.
Looking ahead, AMDA will be
meeting with the CMS’ Long Term
Care Task Force to discuss the use
of a narrative discharge summary.
In written submissions to the task
force, AMDA has asked that hospitals and nursing facilities require a
narrative discharge summary written by a physician, nurse practitioner or physician’s assistant, accompany the patient when there is a
discharge to a nursing home or
home health agency.
Look for updates on the task
force meeting and our work with
the NTOCC in this publication. C
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in
action
Board Updates CMD Requirements
T
he American Medical Directors
Certification Program (AMDCP) board has adopted initiatives
to clarify education requirements.
Physicians pursuing certification
who have taken a geriatric fellowship must have completed the fel-
lowship within 5 years of application. Recertification requires going
to at least one AMDA annual symposium during the 6-year certification period. For details, go to http://
www.amda.com/certification/
application_recertification.pdf. C
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T H E
A S S O C I A T I O N
How to Help the Attending
Physician Work With Hospice
BY ROBERT MCCONNELL, DO
O
ver the years, we have heard multiple
excuses why physicians don’t refer
patients to hospice. Some say it is too expensive, or that the facility
can do as good of a job handling appropriate hospice patients, or that the physician
loses control when hospice
takes over. Others say when
they mention the word “hospice,” patients think they are
being given a death sentence.
Some patients even seem to
be dying but don’t have a terminal diagnosis. These issues present a challenge for
the medical director who seeks to get
physicians to take advantage of the outstanding services of hospice.
As the facility medical director, you can
successfully address these issues with the
attending if you are made aware of the
problem. Start with excellent communication with the director of nursing, nurse
managers, and social service teams. Have
them advise you of problems with the attending when hospice is appropriate and
the physician refuses to consider discussions with the patient and patient families.
Armed with the facts gathered by the
team about the patient’s condition and appropriateness of a hospice referral, begin
addressing any of the physicians’ concerns
in a closed door meeting. It is usually more
effective to have a face-to-face
encounter rather than a phone
call. Let the attending express
all of his or her concerns. You
should take notes so you can
address each issue, and offer
facts to support the referral.
Most challenges come from
a lack of knowledge about the
hospice process including
Medicare rules, proper and appropriate admitting diagnoses, and ancillary hospice
services. The hospice medical director is a
good resource as you address these issues.
One of our most difficult processes is in
stopping medicine when indicated at end
of life. All of our training is in care pathways. Hospice does an excellent job of
helping the attending stop treatment when
it is no longer needed. After that is resolved, you are ready to partner with the
attending on the care team at your facility.
The winner in this process is the patient
who now has all of the care team functionC
ing at its maximum efficiency.
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Mentoring
Tips
Palliative Care Curriculum Offered
A
MDA’s Palliative Care Curriculum
was introduced at the 30th Annual
Symposium. Formatted into two CDROMs, the content includes instructions
for teachers, instruction for self-study,
slides, and handouts. The second CD contains additional references and Web links
for further study. The curriculum is offered as an expansion of the information
and materials provided in the Pain and
Palliative Care topics of the Primer for
Nursing Home Medicine.
The Palliative Care Curriculum includes
templates for symptom assessments as
well as sample forms that can be adapted
to the needs of your facility.
The curriculum can be ordered at
C
www.amda.com/order.
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Western Regions Have Smallest Hospice Caseload
In Skilled Nursing or Long-Term Care Facilities
Opportunities on Ethics Committee
he Ethics Committee presents
another opportunity for members to get involved in AMDA. Its
purpose is to identify issues concerning the ethical conduct of the
association and its members, as
well as issues regarding the
bioethics of health care decisionmaking. It also helps to develop
policy statements that are submitted to the board for action.
In the past, the committee has
worked with the AMDA board of
directors to develop a conflict-ofinterest policy, develop a paper on
Surrogate Decision-Making and Ad-
vance Care Planning in Long-term
Care, develop a White Paper on Ethical and Professional Responsibility of
LTC Providers in Providing Expert
Witness, and provide guidance to
the CMD board on composition of
an unbiased body to review any
submission of a program equivalent to AMDA’s Core Curriculum.
Currently, the committee is helping
to update the 2000 White Paper on
Hospice. To volunteer for this committee, go to www.amda.com/volunteer, or call Kathleen M. Wilson,
director of government affairs, at
C
(410) 740-9743.
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DC
Region 1 37.5% Region 2 26.3% Region 3 23.0% Region 4 27.4% Region 5 41.0%
Region 6 39.0% Region 7 31.8% Region 8 13.1% Region 9 22.6%
Note: Average percentages based on 2005-2006 data from Hospice Salary and Benefits Report.
Source: Hospice Association of America
E LSEVIER G LOBAL M EDICAL N EWS
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